About 45 million Americans with blood pressure levels once considered normal or borderline actually have “prehypertension,” say new government guidelines that urge them to exercise, avoid salt and make other changes to stave off full-blown high blood pressure.
It’s a major change that affects people with blood pressure as low as 120 over 80 -- once thought to be a good level but now considered not good enough.
Scientists now say that damage to arteries from the pressure of blood pounding through them begins to increase at levels as low as 115 over 75. Even a small jump from that low -- to 130 over 85, a level previously considered in the normal range -- means a doubling of the risk of later death from heart disease, say the guidelines by the National Heart, Lung and Blood Institute.
Hence the new emphasis on at least delaying the gradual rise in blood pressure that so many Americans see with age. Still, the report promises to be a shock for people told for years their blood pressure was healthy, only to learn they’re now considered “prehypertensive” unless their level is below 120 over 80.
“We don’t want to frighten the public, we want to get action,” said Dr. Aram Chobanian, dean of Boston University’s Medical School and chairman of the government-appointed committee that drafted the guidelines. “Even small changes in blood pressure are important.”
Other recommendations in the report, published Wednesday in a special online edition of the Journal of the American Medical Assn., are generating controversy as doctors debate what medication is best once hypertension hits.
The guidelines say most people with high blood pressure need at least two medications to control it -- and most should at least try a cheap, old-fashioned diuretic as initial therapy.
But at a meeting Wednesday of hypertension experts, doctors argued that such advice was wrong for many people.
“They haven’t justified those steps,” said Dr. John Laragh of New York Hospital/Cornell University Medical Center, who contends only 35% of people with hypertension have the type that responds to diuretics.
Many of the rest, he said, could do fine with one other drug, such as an ACE inhibitor or beta blocker.
The new guidelines classify normal blood pressure as below 120 over 80 -- and readings anywhere from 120 over 80 up to139 over 89 as prehypertensive.
Prehypertensive people should lose weight if they’re overweight, get regular physical activity, avoid a salty diet and consume no more than two alcoholic drinks a day, the guidelines say.